Evaluating the Role of Social Interactions and Shame in Self-Injurious Behaviors using Ecological Momentary Assessment: Feasibility and Preliminary Evaluation

Self-injurious thoughts and behaviors (SITBs) are increasingly prevalent in the United States. The transactional model of emotion dysregulation provides a framework for understanding the development and maintenance of such behaviors and suggests that shame and self-invalidation following invalidation from others play significant roles. A comprehensive evaluation of this model would include real-time, in-vivo assessment. Ecological momentary assessment (EMA) can be used to assess the moment to moment social responses and subsequent private experiences that may contribute to SITBs. The present study evaluated the feasibilityand acceptability of using EMA methods to test the relationship among antecedent social invalidation and subsequent shame, self-invalidation, and SITBs. Results suggest that procedures were generally acceptable and feasible, though EMA procedures had somewhat low compliance. Preliminary analyses of study variables suggest that social invalidation was significantly associated with subsequent self-invalidation and shame. Social invalidation, self-invalidation and shame were also significantly associated with NSSI urges, but not suicide urges. Shame partially mediated the relationship between social invalidation and NSSI, but self-invalidation did not, and neither was a significant direct predictor of suicide urges. This study is a first step at examining the inter- and intra-personal links among social invalidation, self-invalidation, shame and SITBs in real time

A Randomized Clinical Trial of Acceptance and Commitment Therapy Vs Progressive Relaxation Training for Obsessive Compulsive Disorder

Objective: Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Method: Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and 3-month follow-up by an assessor who was unaware of treatment conditions: Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory–II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. Treatment Evaluation Inventory was completed at posttreatment. Results: ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pretreatment = 24.22, posttreatment = 12.76, follow-up = 11.79; PRT pretreatment = 25.4, posttreatment = 18.67, follow-up = 16.23) and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT (clinical response rates: ACT posttreatment = 46%–56%, follow-up = 46%–66%; PRT posttreatment = 13%–18%, follow-up = 16%–18%). Quality of life improved in both conditions but was marginally in favor of ACT at posttreatment. Treatment refusal (2.4% ACT, 7.8% PRT) and dropout (9.8% ACT, 13.2% PRT) were low in both conditions. Conclusions: ACT is worth exploring as a treatment for OCD

A Randomized Clinical Trial of Acceptance and Commitment Therapy Versus Progressive Relaxation Training for Obsessive-Compulsive Disorder

Objective: Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Method: Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and 3-month follow-up by an assessor who was unaware of treatment conditions: Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory-II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. Treatment Evaluation Inventory was completed at posttreatment. Results: ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pretreatment = 24.22, posttreatment = 12.76. follow-up = 11.79: PRT pretreatment = 25.4, posttreatment = 18.67, follow-up = 16.23) and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT (clinical response rates: ACT posttreatment = 46%-56%, follow-up = 46%-66%; PRT posttreatment = 13%-18%, follow-up = 16%-18%). Quality of life improved in both conditions but was marginally in favor of ACT at posttreatment. Treatment refusal (2.4% ACT, 7.8% PRT) and dropout (9.8% ACT, 13.2% PRT) were low in both conditions. Conclusions: ACT is worth exploring as a treatment for OCD